A Qualitative Study to Identify Perceptual Barriers to Antiretroviral Therapy (ART) Uptake and Adherence in HIV Positive People from UK Black African and Caribbean Communities

Elizabeth Glendinning,Jane Anderson,Rob Horne,Vanessa Cooper,Lucy J Campbell,Johanna Spiers,Jonathan A Smith

doi:10.1007/s10461-019-02670-x

Abstract

To inform the development of interventions to increase uptake and adherence to antiretroviral therapy (ART), we explored perceptions of ART in semi-structured interviews with 52 men and women from UK black African and black Caribbean communities. Verbatim transcripts were analyzed using framework analysis. Perceptions of ART could be grouped into two categories: doubts about the personal necessity for ART and concerns about potential adverse effects. Doubts about necessity stemmed from feeling well, doubts about the efficacy of ART, religious beliefs and the belief that treatment was futile because it could not cure HIV. Concerns about adverse effects included the fear that attending HIV services and taking treatment would lead to disclosure of HIV, feeling overwhelmed at the prospect of starting treatment soon after diagnosis, fears about side effects and potential long-term effects, and physical repulsion. The findings will facilitate the development of interventions to increase uptake and adherence to ART.

Highlights

Effective antiretroviral therapy (ART) has dramatically reduced morbidity and mortality associated with HIV infection [1] and can prevent transmission to sexual partners [2]
Given the lack of current research focusing on perceptual barriers to ART uptake and adherence among black African and black Caribbean people living with HIV (PLWH) in the UK, the aim of this study was to identify the salient perceptual barriers to ART uptake and adherence in a sample of people of black African and black Caribbean descent living with HIV in London
These themes could be grouped under two main categories: five themes were categorized as doubts about the necessity for treatment and five were categorized as concerns about adverse effects (Table 2)

Summary

Introduction

Effective antiretroviral therapy (ART) has dramatically reduced morbidity and mortality associated with HIV infection [1] and can prevent transmission to sexual partners [2]. Modelling studies have shown that if sufficient numbers of people living with HIV (PLWH) are diagnosed and take sustained and effective treatment, new HIV infections could be eradicated within the two decades [4]. The report set out three milestones that would need to be achieved by 2020 in order to reach this target: (1) 90% of all people with HIV knowing their HIV status; (2) 90% PLWH who know their diagnosis receiving continuous treatment and (3) 90% of people with diagnosed HIV having viral suppression [4]. In the UK, the UNAIDS targets had been met [6, 7] Despite these successes, delay to treatment uptake and poor adherence to medication continue to pose important challenges. Several studies show that nonadherence to ART remains suboptimal: a meta-analysis of 84

Objectives

Results

Discussion

Conclusion